Jump to

Abstract

Background: Landmark techniques for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have contributed to the improvement of initial success of PCI of CTO lesions. However, challenges remain remain in the recanalization of CTO lesions in the native coronary artery (NCA) in patients with prior coronary artery bypass grafting (CABG). Thus, the purpose of this study is to compare the initial success rate of NCA-CTO lesions between patients with and without priorCABG, and to speculate the affecting factors.

Methods: Among a total of 13448 PCI cases performed in our hospital from 1999 to 2011, we extracted patients who underwent PCI for NCA-CTO and classified them into two groups: prior CABG patients (pCABG group, 206 PCIs of 153 patients) and non- CABG (nCABG group, 1431 PCIs of 1229 patients).

Results: The patients and lesions background between the two groups were similar. The initial angiographic success rate was numerically higher in the nCABG group than in the pCABG group (83% (1183/ 1431) vs. 72% (148/ 206), P=0.12). The binary restenosis rate of the PCI lesions confirmed by angiography in the chronic phase (median follow up duration: nCABG group: 295±314 days, pCABG group: 328±417 days, P=0.30) between the two groups was comparable (nCABG group: 24% (342/ 1431) vs. pCABG group: 22% (45/ 206), P=0.20).

Conclusions: One of the reasons for inferior success rate in the pCABG group compared to the nCABG group might be due to the frequent necessity to utilize the retrograde micro channel via bypass graft, which could cause more complex procedures and provoke much broader ischemic areas. Despite the lower initial success rate, chronic patency of the PCI lesions was comparable between the two groups, and lower all-cause mortality was confirmed in the succeeded PCI group, which could encourage the interventionalist. This study indicates that more profound tactics will be needed for the revascularization of NCA-CTO lesions in patients who have had prior CABG.